DESCRIPTION: (Applicant's Description) Significant advances have been made in the management of pain and other symptoms in the terminally ill. Studies locally and in the medical literature, however, indicate that large numbers of patients have in adequate relief of pain and other problems prior to death. Quality in palliative care, is dependent on a complex health care delivery system, and the coordination of an interdisciplinary team of providers,in addition to adequate knowledge and skills. In order to improve palliative care delivery, physicians must be able to work within a team and need to understand improvement of health care delivery processes. In this project, medical students, as part of a longitudinal clinical experience, will participate in an interdisciplinary quality improvement team with nurses, staff physicians, hospice team members, support staff and resident physicians to develop a critical pathway for palliative care at three hospitals. The critical pathway will identify steps for delivery of care to terminally ill cancer patients, and will provide on-going education about the process for palliative care to those involved in caring for these patients. Medical students will gain a global understanding of care of the dying from hospice staff, patients and families, hospital staff and chart reviews as part of the data collection for the quality improvement process. A problem-based and interactive curriculum supplements this knowledge. Once developed, a critical pathway for palliative care and the process for integration and ongoing improvement of the pathway will be disseminated to other institutions through the Norris Cotton Cancer Center oncology outreach program, the Vermont Program for Quality in Health Care, and the Veterans Administration National Ethics Center. Our specific aims are to: 1) Develop an ongoing palliative care education program for medical students, resident and staff physicians and other healthcare professionals including hospice team members.2) Foster an understanding for medical students of interdisciplinary healthcare teams, and means of improving healthcare systems through quality improvement efforts.3) Use a continual improvement process to develop a critical pathway for delivering palliative care in three settings, the White River Junction VA Medical Center, the Mount Ascutney Hospital and the Dartmouth Hitchcock Medical Center. Create self-perpetuating palliative care quality improvement through implementation of the critical pathway and ongoing evaluation and modification of the pathway.